Repro10 - Menopause

Question 1

6 menopause definitions

Menopause
Climacteric
Menopausal Transition
Early 
Premature 
Surgical

Answer 1

1. ) Menopause - permanent cessation of menstruation due to loss of ovarian follicular activity
   - no menstrual periods for 12 consecutive months w/ no other biological or physiological cause
   - average age is 50 (45-55)

2.) Climacteric - physiological period where there is regression of ovarian function

3. ) Menopausal Transition - time between onset of irregular menses and menopause
   - average duration is 4 years

4.) Early Menopause - menopause at < 45 years of age

5. ) Premature Menopause - menopause at < 40 years
   - pathological and should be investigated

6.) Surgical Menopause - caused by bilateral oophorectomy

Question 2

4 phases of menopause

Pre-menopause
Peri-menopause
Menopause
Post-menopause

Answer 2

1. ) Pre-menopause - prior to menopause (40+ years)
   - follicular phase shortens, ovulation is early or absent
   - slightly less oestrogen produced –> less -ve FB –> rise in LH and FSH levels (FSH rises more due to no inhibin)
   - results in reduced fertility but menstrual cycles may be relatively unchanged
2. ) Peri-menopause - climacteric/menopausal transition
   - additional physiological changes such as mood swings and hot flashes and greater menstruation infrequency
3. ) Menopause - permanent cessation of menstruation caused by ovarian follicular development failure
   - FSH is used to diagnose physiological menopause
4. ) Post-menopause - time after a woman has experienced 12 consecutive months of amenorrhoea
   - only incapable to conceive at this stage

Question 3

Consequences of oestrogen deficiency/menopause

3 Early
3 Intermediate
3 Late

Answer 3

1. ) Early Consequences - between 40-55
   - vasomotor: hot flushes, sweating
   - psychological: insomnia, mood swings, depression
   - menstrual: menstrual irregularity
2. ) Intermediate Consequences - between 52-65
   - tissues reliant on oestrogen affected
   - vaginal atrophy –> dyspareunia (painful sex)
   - urinary incontinence –> UTIs
   - skin atrophy
3. ) Late Consequences - between 60-70+
   - osteoporosis, Alzheimer’s
   - atherosclerosis –> CHDs and cardiovascular disease

Question 4

5 features of the effects on the vasomotor system (the hot flush)

Description
Symptoms x6
Duration
Frequency
Treatment

Answer 4

1. ) Description - sudden, transient sensation of warmth over face, chest, neck and head
   - followed by lots of sweating
2. ) Symptoms - chills, nausea, anxiety, head or chest pressure, feelings of suffocation, inability to concentrate
3. ) Duration - few seconds to several minutes
4. ) Frequency - rare or recurrent every few minutes
   - more at night or during stress

5.) Treatment - relieved by oestrogen treatment

Question 5

4 changes in general appearance during menopause

Answer 5

1.) Thinner Skin - loses elasticity due to loss of elastin and collagen

2. ) Increase in Weight - due to irregular food habits caused by mood swings
   - more fat deposition around hips, waists, buttocks
3. ) Dry and Coarse Hair - decreasing levels of oestrogen
   - there may also be some hair loss

4.) Deeper Voice - thickening of vocal cords

Question 6

6 features of the effects of menopause on the cardiovascular system

Hormonal Effect
Cholesterol
Glucose Metabolism
Blood Pressure
Body Composition
Cardiovascular Disease

Answer 6

1.) Hormonal Effect - lack of oestrogen and progesterone causes many changes in physiology and metabolism

2. ) Increase in Cholesterol - causes hyperlipidaemia
   - rise in all types of lipids and decrease in HDLs
3. ) Glucose Metabolism - carbohydrate tolerance decrease as insulin resistance increases
4. ) Blood Pressure - increase in systolic and diastolic BP
5. ) Body Composition - increase in body weight and central fat redistribution
6. ) Cardiovascular Disease - major killer in women as gradual rise in risk of heart disease and stroke after menopause

Question 7

2 effects of menopause on the GI and urinary systems

Answer 7

1.) Constipation - motor activity of the entire digestive tract is diminished so the intestines become sluggish

2. ) Urinary Incontinence - decrease in oestrogen levels
   - tissue lining the urethra and bladder become drier, thinner, and less elastic
   - also get increased urinary frequency and risk of UTIs

Question 9

3 effects of menopause on bone

Hormonal Effect
Bone Density
Clinical Condition

Answer 9

1.) Oestrogen Effect - oestrogen suppresses osteoclasts so decrease in oestrogen increases osteoclast activity

2. ) Reduced Bone Density - calcium loss from the bone is increased in the first 5 years of menopause
   - bone mass reduces 2.5 % per year for several years
3. ) Osteoporosis - due to reduced bone density
   - major reason for fractures in later life
   - can be limited by oestrogen therapy

Question 10

Relationship between menopause and dysfunctional uterine bleeding and increased risk of cancer

Oestrogen Deficiency
No Corpus Luteum

Answer 10

1.) Oestrogen Deficiency - causes the endometrium to keep thickening leading to a late menstrual period followed by irregular bleeding and spotting

2. ) No Corpus Luteum - no progesterone produced
   - increased risk of endometrial carcinoma due to effect of unopposed oestrogen

Question 10

4 changes in the genital organs due to menopause

2 Internal Organs
2 External Organs

Answer 10

1. ) Uterus - becomes small and fibrotic
   - due to atrophy of the endometrium and myometrium
2. ) Cervix - becomes smaller and blends with vagina
   - thinning of cervix and vaginal rugae is lost

3.) Vulva - fat in the labia majora and the mons pubis decreases and pubic hair becomes spare

4. ) Breasts - changes depends on woman’s size
   - in thin women, they become flat and shrivelled
   - in heavy women, they remain flabby and pendulous

Question 11

2 forms of treatments for menopause

Answer 11

1. ) Non-hormonal Treatments
   - wearing less layers, avoiding caffeine, alcohol, and spicy foods can alleviate hot flashes and night sweats
   - reducing dietary intake and regular exercise can help combat weight gain
2. ) Hormone Replacement Therapy (HRT)
   - replaces hormones to minimise menopause symptoms
   - can be used during and after menopause
   - administered in pill form, vaginally (cream), transdermally (patch)